高频重复经颅磁刺激对早期帕金森病轻度认知功能障碍的疗效观察

Clinical observation of high frequency repetitive transcranial magnetic stimulation on mild cognitive impairment in early Parkinson’s disease

目的探讨高频重复经颅磁刺激(rTMS)治疗对早期帕金森病(PD)患者轻度认知功能障碍(MCI)的临床疗效。方法将60例早期PD伴发MCI患者随机分为rTMS组和对照组,每组30例。以左前额叶背外侧皮质为刺激区域,rTMS组予以10 Hz高频rTMS,对照组予以伪刺激处理。比较两组治疗前后蒙特利尔认知评估量表(MoCA)评分及P300变化。结果与治疗前比较,对照组治疗后MoCA量表总分及各子项评分差异无统计学意义(均P>0.05),rTMS组治疗后MoCA量表总分、记忆评分显著升高(均P<0.05),余MoCA量表子项差异无统计学意义(均P>0.05)。与对照组比较,rTMS组治疗前MoCA量表总分及各子项评分无统计学意义(均P>0.05),治疗后MoCA量表总分及记忆评分显著升高(均P<0.05),余MoCA量子项差异无统计学意义(均P>0.05)。与治疗前比较,对照组治疗后P300潜伏期、波幅差异无统计学意义(均P>0.05),rTMS组治疗后P300潜伏期显著降低,波幅显著升高(均P<0.05)。与对照组比较,rTMS组治疗前P300潜伏期、波幅差异均无统计学意义(均P>0.05),治疗后rTMS组P300潜伏期显著降低,波幅显著升高(均P<0.05)。本研究不良反应均轻微而短暂,休息后很快缓解,未见严重不良反应。结论高频rTMS能够改善早期PD患者的MCI,且主要体现在提高记忆能力上。

Objective To investigate the clinical efficacy of high frequency repetitive transcranial magnetic stimulation(rTMS) on mild cognitive impairment(MCI) in patients with early Parkinson’s disease(PD). Methods Sixty early PD patients with MCI were randomly divided into rTMS group and control group, 30 cases in each group. The dorsolateral cortex of the left prefrontal lobe was the stimulation area. The rTMS group was treated with 10 Hz high-frequency rTMS, and control group was treated with pseudo-stimulation. The Montreal cognitive assessment(MoCA) score and P300 change of the two groups before and after treatment were compared. Results Compared with those in pre-treatment, there was no significant difference in the total score and the score of each sub-item of MoCA in control group after treatment(all P>0.05), the total score and memory score of rTMS group were significantly increased after treatment(all P<0.05), the other MoCA sub-items had no significant difference(all P>0.05). Compared with those in control group, the total score and each sub-item score of MoCA in rTMS group had no significant difference before treatment(all P>0.05), the total score and memory score of MoCA in rTMS group were significantly increased after treatment(all P<0.05), there was no significant difference in the other MoCA sub-item(all P>0.05). Compared with those in pre-treatment, there was no significant difference in P300 latency and amplitude in the control group after treatment(all P>0.05), the P300 latency was significantly decreased and the amplitude was significantly increased in rTMS group after treatment(all P<0.05). Compared with those in control group, there was no significant difference in P300 latency and amplitude in rTMS group before treatment(all P>0.05), the P300 latency was significantly decreased and amplitude were significantly decreased in rTMS group after treatment(all P<0.05). The adverse reactions in this study were mild and short, relieved quickly after rest, and no serious adverse reactions were found. Conclusion High-frequency rTMS can improve mild cognitive function in patients with early PD, and it is mainly reflected in improving memory ability.